Comments on: Riskhttp://frontierpsychiatrist.co.uk/risk/
Sat, 26 Jan 2019 13:40:08 +0000hourly1http://wordpress.org/?v=3.6.1By: 2010-10-22 Spike activity « Mind Hackshttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-118329
2010-10-22 Spike activity « Mind HacksFri, 22 Oct 2010 15:47:13 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-118329[...] an excellent piece on how the concept of risk became central to psychiatry over the Frontier [...]
]]>By: Christopher Crookhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-116529
Christopher CrookMon, 18 Oct 2010 09:31:28 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-116529@ Jean Davison
Congratualations.
I could write an encyclopedia! I haven’t as yet.
]]>By: Jean Davisonhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-116357
Jean DavisonSun, 17 Oct 2010 20:29:15 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-116357@Christopher Crook
I was being a bit jokey when I said “I could write a book about this!” because actually I have done (published last year). Thanks for the site link to your book; I’ll take a look.
]]>By: Christopher Crookhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-116179
Christopher CrookSun, 17 Oct 2010 10:50:20 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-116179@ Jean Davison
I have written a book about this! You can read the whole thing if you register at http://www.authonomy.com and search for Christopher Crook.
]]>By: Jean Davisonhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-115855
Jean DavisonSat, 16 Oct 2010 12:09:25 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-115855@declerambault
I think we need to be careful about statistics and the way statistics are interpreted. As Christopher Crook points out, it does seem that violent people are more likely to be called schizophrenic, rather than people diagnosed with schizophrenia more likely to be violent. It seems also that the validity of a schizophrenia diagnosis is questionable (with psychiatrists sometimes disagreeing about who does or doesn’t fit the diagnostic criteria for schizophrenia), so how does that skew the studies and statistics? Violent behaviour is rare among persons diagnosed with schizophrenia. Other factors, such as substance abuse, bring higher ratings of violence than for people with schizophrenia.

Discussion about risk should acknowledge that risk does not flow just one way. A person diagnosed with schizophrenia is more likely to be at risk FROM others than TO others. They face the risk of damage done by stigmatisation (often due to public perceptions of dangerousness). They are also at risk from mental health services, which I can’t go into at length here (I could write a book about this!).

It seems to me unhelpful to use figures about risk from those diagnosed with schizophrenia to suggest these confirm the need for coercion, without looking at the full picture. It’s far more complicated than that.

Nobody is sectioning drivers for tearing down the motorway with mobile phones clamped to their ears (psychiatric hospitals in my area would be full to overflowing if they were). Yet they put far more people at risk than those with a schizophrenia diagnosis.

]]>By: Christopher Crookhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-115534
Christopher CrookFri, 15 Oct 2010 11:47:09 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-115534@declerambault
I’d hazard violent people are more likely to be called schizophrenic, not schizophrenics are more likely to be violent.
]]>By: declerambaulthttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-115514
declerambaultFri, 15 Oct 2010 10:24:45 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-115514@Chritopher
As FP’s post suggests: risk is a complicated issue in psychiatry and an emotive one, when one considers overzealous risk management can lead to unecessary deprivation of liberty. Similarly, in not taking risk assessment seriously (and I’m thinking in this instance of risk of violence), psychiatrists are doing a disservice to their patients, their patients’ families and society at large, when suboptimal treatment and risk management permits sometimes preventable violence.

The ideas of risk are important for society to debate not just the profession. You may disagree with my position which is of course part of any healthy debate however I’m not quite sure which “massive generalisation” you take issue with or what you disagree with.

Another fact that I hope you won’t take as a generalisation is that the prevalence of schizophrenia amongst homicide offenders in Sweden is 9%, which is significantly greater than the population as a whole (and of the Uk’s 5%). I’m not sure why it’s higher. Do they have better or worse access to psychiatric services? A more coercive or more liberal mental health law?

These issues need to be discussed, mindful of stigma I say once again: the vast majority of mentally ill individuals are not of risk to others, however as a group people with mental disorder have an increased risk of perpetrating violence.

]]>By: Jean Davisonhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-115237
Jean DavisonThu, 14 Oct 2010 15:19:59 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-115237That’s a good and interesting posting, FP (one coffee coming up). I would like to add my views, though I am not a psychiatrist (heaven forbid!). I’m a former service user who has never presented a risk to others (and whose only risk to self was in volunteering myself for psychiatric treatment in the sixties).

I think psychiatrists are put in an incredibly difficult position when they’re expected to decide if someone might pose a risk and take responsibility for it. If psychiatrists use coercion to prevent the possibility of a person becoming dangerous, they’ll be criticised. Psychiatrsts will also be criticised if they don’t do this and then the person does act violently. But risk assessment is bound to be fallible, and people shouldn’t lose their liberty on the basis of what they might or might not do in the future.

Blimey, it’s complicated! Psychiatrist have my sympathy on this one. They can’t win.

]]>By: Chritopher Crookhttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-115188
Chritopher CrookThu, 14 Oct 2010 13:04:28 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-115188@ declerambault
You’ve made some massive generalisations and seem to want to argue not discuss. You sound dangerous to me and I think you should be locked up.
]]>By: declerambaulthttp://frontierpsychiatrist.co.uk/risk/comment-page-1/#comment-114783
declerambaultWed, 13 Oct 2010 13:22:20 +0000http://frontierpsychiatrist.co.uk/?p=1339#comment-114783I agree that defensive and over cautious practice can impede thinking in general, however I do think the profession whilst not “responsible” for the patients’ behaviour is certainly responsible for helping said patients take responsibility, considering risks to self or others and intervening where necessary. Psychiatrists have often been more comfortable with risk to self (rather than others) particularly in the context of psychotic or affective disorder.

Unfortunately some psychiatrists seem to think they can pick and choose what exactly it is they are responsible for. It might be nice for some to consider Psychiatry the domain of psychotic and affective disorders only, but we know that’s simply not the case. Psychiatry is the medical treatment of mental and behavioural disorders, and that might mean antsocial, illegal or problemtic behaviour, either in an ICD/DSM category of its own or those commonly (if not diagnostically) associated with severe mental illness.

Like it or not psychiatry’s a risky business, and despite that vast majority of patients being non-violent, the disorders confer upon them a higher actuarial risk of violence:

Psychosis is more prevalent in prisoners remanded for violent offences than non-violent offences.
Amongst homicide offenders in the UK there’s a 5% prevalence of schizophrenia (commonly quoted as 1% in the general popn.)

As I’ve said whilst most patients are non-violent being aware of the associated risk between mental disorder and violence, is part of the business of psychiatry. Ignoring that and conveniently adopting moral concepts of free will when people do bad things yet not when they’re barking mad but well behaved isn’t helping the patient, society or the profession.